哮喘联盟

   摘要
   背景：在这项研究前，哮喘患者全因死亡率已被证实。多重致敏在儿童哮喘患者中发病率较高，过敏性鼻炎和/或过敏性结膜炎（AR /AC）在成年哮喘患者中发病率较高。关于AR /AC及其他因素对成人哮喘患者死亡率的影响，目前知之甚少。本研究的目的是探讨哮喘或非哮喘成人的死亡率及其危险因素。
   方法：我们从国家登记处随机选择了1648位、年龄超过30岁的哮喘患者，每名患者与一个或两个对照匹配。1997年通过问卷获得基线资料，收集从1997年至2013年研究人口在芬兰统计局登记的死亡数据。通过多种调整后模型比较组间总体生存率和特定原因生存率的差异。
   结果：在平均随访时间为15.6年的随访周期内，1052例哮喘患者中有221人死亡，1889非哮喘患者中有335人死亡。心血管疾病是两组人群死亡的主要原因。哮喘与全因死亡率增加相关（调整后的HR 1.25；95% CI 1.05-1.49，P = 0.011）；同事以及慢性阻塞性肺疾病导致的死亡率（HR 12，4.18-34.2，P＜0.001）和呼吸器官恶性肿瘤（HR 2.33，1.25-4.42，P = 0.008）也存在相关性。在哮喘患者中，吸烟与较高的全因死亡率增加相关，自我报告的过敏性鼻炎和/或过敏性结膜炎（AR /AC）与较低的死亡率相关。在非哮喘患者，吸烟和肥胖与较高的全因死亡率相关。死亡风险同时存在性别差异，女性患者风险较低。
   结论：成人哮喘患者死亡率的增加很大程度上可以用发生了慢性阻塞性肺疾病、恶性呼吸道肿瘤和心血管疾病来解释。戒烟对降低哮喘和非哮喘患者的总死亡率都非常重要。只有哮喘患者中观察到过敏性鼻炎和/或过敏性结膜炎（AR /AC）与死亡率下降相关。因此，需要在更大规模的人群进行研究，进一步探讨这种联系的性质。

 

 (中日友好医院医院呼吸与危重症医学科 张科文 摘译 林江涛 审校)
(Allergy. 2018 Feb 20. doi: 10.1111/all.13431.)

 

Higher mortality of adults with asthma: a 15 year follow-up of apopulation-based cohort
 
Lemmetyinen RE, Karjalainen JV, But A, Renkonen RLO, Pekkanen JR

Abstract

BACKGROUND: Higher all-cause mortality in asthmatics has been shown previously. Polysensitization is associated with higher morbidity among asthmatic children, and allergic rhinitis and/or allergic conjunctivitis (AR/AC) is associated with higher morbidity in adult asthmatics. Little is known about the effect of AR/AC and other factors on mortality among adult asthmatics. The aim was to study mortality and its risk factors in adults with and without asthma.

METHODS: We randomly selected 1648 asthmatics with age over 30 years from national registers and matched the asthma sample with one or two controls. Baseline information was obtained by a questionnaire in 1997, and the study population was linked with the death certificate information of Statistics Finland from 1997 to 2013. Overall and cause-specific survival between the groups was compared in several adjusted models.

RESULTS: During a mean follow-up period of 15.6 years, 221 deaths among 1052 asthma patients and 335 deaths among 1889 non-asthmatics were observed. Cardiovascular diseases were the main cause of death in both groups. Asthma was associated with increased all-cause mortality (adjusted HR 1.25; 95% CI 1.05-1.49, P=0.011); as well as mortality from chronic obstructive pulmonary disease (HR 12.0, 4.18-34.2, P<0.001) and malignant neoplasms of respiratory organs (HR 2.33, 1.25-4.42, P=0.008). Among asthmatics, smoking was associated with increased all-cause mortality and self-reported AR/AC was associated with decreased mortality. Among non-asthmatics, smoking and obesity were associated with increased all-cause mortality, whereas female gender showed an association with a decreased risk.

CONCLUSIONS: Increased mortality among adult asthmatics was largely explained by the development of COPD, malignant respiratory tract neoplasms and cardiovascular diseases. Smoking cessation is important for reduction of total mortality in both asthmatic and non-asthmatic adults. AR/AC was associated with decreased mortality only in asthmatics. Thus, studies in other populations of larger size are needed to explore further the nature of this association.